Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
Br J Cancer. 2023 Mar;128(7):1286-1293. doi: 10.1038/s41416-023-02153-w. Epub 2023 Jan 30.
Brain metastases (BM) are common among HER2+ breast cancer (BC) and prognostic stratification is crucial for optimal management. BC-GPA score and subsequent refinements (modified-GPA, updated-GPA) recapitulate prognostic factors. Since none of these indexes includes extracranial disease control, we evaluated its prognostic value in HER2+ BCBM.
Patients diagnosed with HER2+ BCBM at Istituto Oncologico Veneto-Padova (2002-2021) and Montpellier Cancer Institute (2001-2015) were included as exploratory and validation cohorts, respectively. Extracranial disease control at BM diagnosis (no disease/stable disease/response vs. progressive disease) was evaluated.
In the exploratory cohort of 113 patients (median OS 12.2 months), extracranial control (n = 65, 57.5%) was significantly associated with better OS at univariate (median OS 17.7 vs. 8.7 months, p = 0.005) and multivariate analysis after adjustment for BC-GPA (HR 0.61, 95% CI 0.39-0.94), modified-GPA (HR 0.64, 95% CI 0.42-0.98) and updated-GPA (HR 0.63, 95% CI 0.41-0.98). The prognostic impact of extracranial disease control (n = 66, 56.4%) was then confirmed in the validation cohort (n = 117) at univariate (median OS 20.2 vs. 9.1 months, p < 0.001) and multivariate analysis adjusting for BC-GPA (HR 0.41, 95% CI 0.27-0.61), modified-GPA (HR 0.44, 95% CI 0.29-0.67) and updated-GPA (HR 0.42, 95% CI 0.28-0.63).
Extracranial disease control provides independent prognostic information in HER2+ BCBM beyond commonly used prognostic scores.
脑转移（BM）在 HER2+ 乳腺癌（BC）中很常见，预后分层对于最佳管理至关重要。BC-GPA 评分及其后续的改进（改良-GPA、更新-GPA）再现了预后因素。由于这些指标都不包括颅外疾病控制，因此我们评估了其在 HER2+BCBM 中的预后价值。
分别纳入 2002-2021 年在 Istituto Oncologico Veneto-Padova（探索性队列）和 2001-2015 年在 Montpellier Cancer Institute（验证性队列）诊断为 HER2+BCBM 的患者。评估 BM 诊断时颅外疾病控制情况（无疾病/稳定疾病/有反应与进展性疾病）。
在探索性队列的 113 例患者（中位 OS 12.2 个月）中，无颅外疾病控制（n=65，57.5%）与单因素（中位 OS 17.7 与 8.7 个月，p=0.005）和多因素分析（校正 BC-GPA 后，HR 0.61，95%CI 0.39-0.94）、改良-GPA（HR 0.64，95%CI 0.42-0.98）和更新-GPA（HR 0.63，95%CI 0.41-0.98）后更好的 OS 显著相关。随后，在验证性队列（n=117）中，颅外疾病控制（n=66，56.4%）的预后影响在单因素（中位 OS 20.2 与 9.1 个月，p<0.001）和多因素分析（校正 BC-GPA 后，HR 0.41，95%CI 0.27-0.61）、改良-GPA（HR 0.44，95%CI 0.29-0.67）和更新-GPA（HR 0.42，95%CI 0.28-0.63）中得到证实。
颅外疾病控制在 HER2+BCBM 中提供了独立于常用预后评分的预后信息。
